Fuller, Renate Selene

Fuller, Renate Selene is an individual health care provider with primary practice located at 518 Jefferson Plz , Port Jefferson Station NY 11776-1104. She recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as her primary health care specialty. Fuller, Renate Selene can be contacted via phone (631) 476-8334.

Contact Information

Primary practice address
518 Jefferson Plz Port Jefferson Station NY 11776-1104
Phone: (631) 476-8334
Fax: (631) 476-0749
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 048137 New York

Profile Details

NPI number 1184807117
LBN Legal business name Fuller, Renate Selene
Credentials RPH
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2007
Last updated Sep 6th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184807117 NPPES
New York MEDICAID 01869410

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